Google
the terms “hangover treatment”, and in 0.07 seconds, you’ll get about 1,800,000
hits. Clearly, many people are eager to find the solution to that horrible
feeling they get when they wake up after a night of heavy drinking. According
to a survey by Harburg, Gunn, Gleiberman, DiFranceisco, & Schork (1993),
approximately 75% of people who drank to intoxication had experienced hangovers
some time in their life. The internet is a hotspot for those individuals who
are seeking help. However, with so many different remedies offered on the net,
as well as those suggested by friends, family, etc., how are we to know which
ones really work? Here, we will investigate the various hangover treatments
suggested on the web and compare them with controlled clinical studies on the
topic.

What
characterizes a hangover?

A
hangover, which is medically known as veisalgia, is your body’s way of
telling you that you’ve had too much to drink. According to Swift &
Davidson (1998), there is an array of physical symptoms associated with
hangovers, such as headache, fatigue, nausea, dehydration, increased
sensitivity to light and sound, drowsiness, body aches, vertigo, and for some
people, cognitive and mood disturbances, such as depression, anxiety, and
irritability. Additional symptoms are gastrointestinal problems (such as
stomach pain and vomiting), sleep disturbances, and sympathetic hyperactivity,
such as sweating, tremor, and increased blood pressure (http://biology.about.com/od/physiology/
a/alcohol hangover.htm). The commonalities between symptoms of mild alcohol
withdrawal and veisalgia have indicated that hangovers maybe a form of mild
alcohol withdrawal. However, there still are clear distinctions between the
two, such as time period of impairment, presence of hallucinations and seizures,
and number of episodes of heavy drinking (Swift & Davidson, 1998).

Why
do hangovers occur?

There are several aspects to
heavy drinking that can lead to hangovers. A direct effect of alcohol is
dehydration. Alcohol is a diuretic, which means that it naturally dehydrates
the body because it causes the body to increase urinary output. Additionally,
vomiting that occurs after excessive drinking further dehydrates the body and
also leads to electrolyte imbalance. This combination of dehydration and
electrolyte imbalance produces the hangover symptoms of thirst, headache, and
dizziness (Swift & Davidson, 1998).

Another
direct effect of alcohol is gastrointestinal disturbances, such as irritation
of the stomach and intestines, inflammation of the stomach lining, and delayed
stomach emptying. Furthermore, excessive consumption of alcohol can lead to an
accumulation of fat compounds in liver cells, resulting in what is known as
“fatty liver”. Alcohol also promotes excess gastric acid production. All of
these factors can lead to the stomach pain and general queasy feeling
experienced during a hangover (Swift & Davidson, 1998).

The symptoms of fatigue, mood
disturbances, and weakness can be attributed to alcohol’s direct effect of
lowering blood sugar levels. Alcohol metabolism causes the body to build up
chemicals that hamper glucose production (Swift & Davidson, 1998), which
would decrease the glucose in our bloodstreams. Additionally, alcohol breaks
down glycogen, which is the body’s stored energy, in the liver to glucose,
which is then expelled in urine (http://www.talkingalcohol.com/index.
asp?pageid=116).

An
important non-direct effect of alcohol is the accumulation of acetaldehyde,
which is a toxin, during alcohol metabolism. When alcohol is broken down in the
liver by the enzyme alcohol dehydrogenase (ADH), acetaldehyde is produced as a
byproduct (refer to Figure 2). Acetaldehyde is a poison in our bodies,
so it gets broken down further into the harmless product acetate by the
combination of glutathione, which contains large quantities of cysteine (an
amino acid), and acetaldehyde dehydrogenase (ALDH), which is another enzyme (http://health.howstuffworks.com/hangover4.htm).
This acetate is excreted from the body in our urine. However, when we consume
too much alcohol, our bodies are overwhelmed and cannot effectively metabolize
all the acetaldehyde that is being produced. Essentially, our bodies cannot
keep up because we don’t have enough ALDH or glutathione, so the acetaldehyde
builds up. This toxin is what causes “sweating, rapid pulse, skin flushing,
nausea, and vomiting” (http://findarticles.com/p/articles/mi_
g2603/is_0004/ai_2603000405/).

Figure
2. Metabolism of
alcohol (2004). Note: Copyright American

Society
of Health-System Pharmacy, 2004.

There
are additional explanations for hangovers, such as personality type, compounds
besides alcohol in drinks, family history for alcoholism, etc. (Swift &
Davidson, 1998). However, the common prevention and treatment of veisalgia
usually target the metabolism of acetaldehyde or direct effects of alcohol,
which were discussed above.

What does the
internet suggest?

Imagine
opening your eyes slowly after waking from a long night of partying and
drinking. You’re whole body hurts. Your head is pounding, your stomach is
churning and aching, your breathe smells like vodka, and the room is spinning.
You gradually get yourself out of bed and try not to throw up during the
process. You make it to your desk, open your laptop, and search for hangover
cures on the internet. One website offers a prevention pill for $16.95. It’s
definitely too late for that. Another tells you to drink more alcohol (the hair
of the dog technique). Another website tells you of different cures from around
the world, ranging from drinking tomato juice with pickled sheep’s eyes to
eating a dried bull’s penis (http://www.strangecosmos.com/content/item/140194.html).
You groan as you read all the strange remedies. You’re stomach is not happy. Let’s
see what else you find.

Website #1 – MedlinePlus

When you type in “hangover
treatment” in your search engine, the first website you land on is MedlinePlus,
which is accredited by the American Accreditation
HealthCare Commission (also known as URAC). According to this site, you
should drink slowly and in moderation to prevent hangovers, which makes sense
because this will regulate the amount of alcohol consumed. Also, a glass of
water is suggested between alcoholic drinks to decrease alcohol intake and
dehydration.

If you already have a hangover, the
website suggests you to “consume foods and drinks that contain fructose (such
as fruit juice or honey)” because “there is some evidence that fructose will
help your body burn the alcohol faster” (http://www.nlm.nih.gov/
medlineplus/ency/article/002041.htm). Another suggestion is to rest and eat
well. An example of good food is bouillon soup to restore the depleted salt and
potassium. They also discourage the use of medication containing acetaminophen,
because it may cause damage to the liver in conjunction with alcohol (http://www.nlm.nih.gov/
medlineplus/ency/article/002041.htm).

There is no reference to any
scientific study that supports these statements anywhere on the website, but it
is a reputable website that is made for the sole purpose of providing accurate
and useful information to the public. There is absolute no advertisement or
endorsement of any company or product found on the website. On the bottom of
the page, it states that the website “follows rigorous
standards of quality and accountability. A.D.A.M. is among the first to achieve
this important distinction for online health information and services” (http://www.nlm.nih.gov/medlineplus/ency/
rticle/ 002041.htm). Furthermore, the website gathers
“authoritative information from NLM, the National Institutes of Health
(NIH), and other government agencies and health-related organizations” and is a
government agency (http://www.nlm.nih.gov/medlineplus/
aboutmedlineplus.html). With information from well known and official
agencies, it’s difficult not to take the website’s recommendations for
prevention and treatment for hangovers.

The
second website from your search results offers home remedies for hangovers.
According to iloveindia.com, “the best remedy to cure hangover at home would be
to increase the intake of vitamin C in the body. Consume fresh citrus fruit
juice in large amounts in the morning to cure hangover” (http://www.iloveindia.
com/home-remedies/hangover.html). Similar to the first website, this page
also recommends increasing your intake of water and consuming honey, which has
high levels of fructose.

However,
it also advises drinking “several cups of strong coffee. This would reduce or
lessen the effect” (http://www.iloveindia.com/homeremedies/hangover.html).
Since coffee is a diuretic and the body is already dehydrated from the alcohol,
this seems a bit counterintuitive. Although coffee may act as a stimulant to
counter the sluggish feeling during a hangover, it could ultimately worsen the
hangover by further dehydration.

This
webpage is covered with advertisements on all four sides of the page (top,
bottom, left, and right), and there is absolutely no reference to any
scientific study to substantiate the claims. From first glance, it is
noticeable that the aim of the site is to sell a variety of products, such as
cures for hangover, acne, prostate cancer, hair loss, etc. There is even a
disclaimer (with a grammatical error) in very small letters on the bottom of
the page stating, “iloveindia.com does not warrant or assume any legal
liability or responsibility for the accuracy, completeness or usefulness of the
information provided here. Please check with a expert before using any of the
suggestions given in this article” (http://www.iloveindia.
com/home-remedies/hangover.html). This statement alone indicates that the
website probably has some unreliable suggestions.

Website
#3 – HowStuffWorks.com

You
stumble across a familiar website www.HowStuffWorks.com, owned by Discovery
Communications, that reviews effective (factual) and ineffective (fictional)
hangover cures (http://health.
howstuffworks.com/hangover6.htm). The first common remedy they discuss is
“the hair of the dog”, which involves consuming more alcohol during a hangover.
This is a fictional remedy, according to the website. Although it may lessen
hangover symptoms at first, you are just delaying the symptoms because more
toxins are ingested into the body, which will eventually have to be processed.
This rationale makes logical sense because the body will crash at some time
after consuming too much alcohol.

The second myth the website exposes
is the lessening of symptoms by eating burnt toast. People believe that the
carbon in the burnt bread can “act like a filter in the body” (http://health.howstuffworks.com/hangover6.htm).
Although it’s fact that activated charcoal (“which is a treated form of
carbon”) is used in the absorption of certain kinds of poisons, “it’s not
currently used to treat alcohol poisoning”, and the carbon from burnt toast is
not equivalent to activated charcoal (http://health.howstuffworks.com/hangover6.
htm).

Another
fictional remedy posted is black coffee, because it acts as a diuretic and
further dehydrates the body (this opposes the suggestion from iloveindia.com to
drink plenty of coffee).

The
effective remedies suggested on the website are eggs, water, and fruit juices.
The explanations for water and fruit juices are similar to the ones written by
the MedlinePlus website. Water rehydrates the body, and fruit juices, which
contain high levels of fructose, have been proven to “increases the rate at
which the body gets rid of toxins such as those left over from alcohol
metabolism” (http://health.
howstuffworks.com/ angover6. htm). Additionally, fruit juices are high in
vitamins C and B, which are depleted during and after intoxication, so drinking
juice can be effective in treating hangover symptoms. The eggs are suggested because they
contain large amounts of cysteine, which aids acetaldehyde metabolism in the
liver’s glutathione (which, as discussed before, is easily depleted).

Although
the website has no references to experimental studies, the website claims that
“HowStuffWorks, a wholly owned subsidiary of Discovery Communications, is the
award-winning source of credible, unbiased, and easy-to-understand explanations
of how the world actually works” (http://www.howstuffworks.com/
about-hsw.htm). Since the Discovery Channel, which is another subsidiary of
Discovery Communications, is often viewed as a reputable source, many people
may conclude that this website should also be reliable. However, there are
advertisements for hangover cures and pills found on the webpage, which might
be an indication that there may be another purpose for certain hangover
suggestions. In spite of all the ads, nothing in their actual written
explanation seems biased, so the main purpose of the site is probably to
provide the public with unbiased information.

Website
#4 - WebMD

There are about 1,799,997 more
websites for your search results, so you decide to go to WebMD, which is known
to offer credible news and information. According to this website, carbon has
not been scientifically proven to target and block the absorption of
hangover-inducing elements found in alcohol (http://www.webmd.com/balance/features/
hangover-helpers). Thus, it does not recommend buying products containing
carbon that claim to do so. WebMD also discourages the hair of the dog remedy,
much like the MedlinePlus website, because the body will eventually crash and
the habit could possibly lead to a drinking problem. The only real remedy that
the website suggests is time, because the body has to detoxify the excess
alcohol on its own.

The information given by this
website appears reliable, even though there are a few advertisements on the
page (none of which promote a hangover cure). WebMD is reviewed by the
Independent Medical Review Board, and their mission is to provide the public
with “objective, trustworthy, and timely health information” (http://www.
webmd.com/about-webmd-policies/default.htm?ss=ftr). Additionally, it is
commonly known to give reliable information, so the suggestions can most likely
be take as useful and based on science.

Although reputable (as well as not
so reputable) websites have given suggestions for hangover treatments, which
treatments actually work? In order to find the solution to this question,
results of clinical research should be explored.

What do clinical studies suggest?

Here, we
will look at different studies that have tested the effects of cysteine (the
compound found in eggs), vitamin B, and sugars (glucose, sucrose, and fructose)
in the alleviation of hangover symptoms.

Studies
on Cysteine and Vitamin B

A study done by Sprince, Parker,
Smith, & Gonzales (1974) investigated the protective effects of various
concentrations and mixtures of L-cysteine, thiamine (vitamin B1),
and L-MTCA (L-2-methylthiazolidine-4-carboxylic acid, which is a compound produced when
L-cysteine interacts with acetaldehyde) on the absorption of acetaldehyde,
which, as mentioned before, is a toxin. It is thought that all of these
compounds soak up excess acetaldehyde in the body. Sprince et al. administered
the LD-90 dose of acetaldehyde (the dosage that would kill about 90% of the
rats in 24 hours) to 45 rats in 9 groups (1 control group using saline and 8
experimental groups; thus, 5 rats per group). The experimental groups were
given L-cysteine, thiamine (vitamin B1), and L-MTCA alone, or
different combinations of the compounds prior to the oral administration of the
acetaldehyde. The tests were conducted on 3 consecutive days, so each group
tested 15 rats in total (5 rats/groups x 3 days = 15 rats/group).

The
results of the experiment indicated that the pre-treatment combination of
L-cysteine and thiamine (vitamin B1) completely blocked the LD-90
dosage of acetaldehyde, which means that all of the rats given this mixture
survived. Even when the thiamine concentration was decreased , this combination
resulted in an 87% survival rate of the rats. The survival rates for rats
solely given dosages of L-cysteine, L-MTCA, and thiamin were 80%, 75%, and 90%
respectively. The findings suggest that all of these compounds, when given in
the right concentration, may have protective effects against acetaldehyde
poisoning. However, it’s important to note that results from animal testing may
not mirror results that could be obtained from human testing. It would clearly
be unethical to repeat this exact experiment on human beings, but a modified
version would be useful. Based on this experiment, it seems as though cysteine
(in eggs) and vitamin B are effective in soaking up the toxin acetaldehyde from
the body.

In 2003, Ozaras, Tahan, Aydin,
Uzun, Kaya, & Senturk studied the effect of a cysteine-derivative called
N-acetylcysteine (NAC) on alcohol-induced free radical damage in the liver of
rats. The researchers used 24 male Wistar-Albino rats and divided them into 3
groups. One group was given ethanol. The second group was given NAC and
ethanol, which were respectively injected intragastrically 4 hours apart. The
last group was given isocaloric dextrose. After a month since the start of the
experiment, the rats were sacrificed, and their serum alcohol levels,
glutathione peroxidase levels, and biochemistry were studied. The researchers
found that the co-administration of NAC reduced ethanol-induced liver damage in
rats. In other words, the protective effects of cysteine against alcohol were
found again in this study. Ozaras et al. explains that NAC attenuates liver
damage by elevating intracellular gluthathione concentrations, which is
necessary for metabolizing acetylaldehyde. Although the results are favorable
in supporting the use of cysteine for a hangover treatment, one must keep in
mind that, like the previous study, this experiment was tested on animal
subjects, not human beings. Furthermore, the sample size for each group was
quite small (n=8 per group), so a larger sample size would provide stronger
supporting data.

A
study on the effectiveness of pyritinol (an analog of vitamin B6) in
preventing hangover was launched by Khan, Jensen, & Krogh (1973). The
researchers set up three parties, but only used the first two parties in their
study. There were 11 healthy men and 6 healthy women who volunteered to
participant, and at the parties, there was no restriction for their alcohol
consumption. In the middle of the first party, half of the people were given
placebos, while the remaining received pyritinol. At the second party, the
participants received three dosages of pyritinol – at the beginning, middle,
and end of the party. The next day, the participants were visited by an
observer, who gave them a checklist of hangover symptoms. Khan et al. (1973)
found that “participants developed fewer symptoms after pyritinol than after
placebo” (p.1198). This study suggests that pyritinol, which is a form of
vitamin B6, has protected effects against induced hangover symptoms.
The strength of this study is in the naturalistic aspect of the experiment
setting. Khan et al. was able to recreate a conventional party atmosphere,
which decreases distractions in participants and allows them to act more
normally than in a laboratory. If the procedure were repeated (including more
subjects) and similar results were found, then this would further substantiate
the idea that pyritinol can help in the prevention of hangovers.

Studies
on Sugars (Glucose, Fructose, and Sucrose) and Hangovers

Ylikahri,
Leino,Huttunen, Pösoö, Eriksson, & Nikkilä (1976) tested the effects of fructose and glucose on
the intensity of alcohol intoxication and hangover in 109 male participants.
The volunteers fasted for 10 hours and were then administered 1.75 g of ethanol
per kilogram of body weight of ethanol for 3 hours under controlled laboratory
conditions. Either fructose or glucose was given at the same time as ethanol
administration or during the hangover period (12 hours after ethanol was
given). Within the 20 hours of the experimental period, the intensity of
alcohol intoxication and hangover was recorded 10 times using subjective and
objective rating scales. Additionally, other physiological levels were
measured.

The
results of this experiment showed that there were no significant effects of
either sugar on the intensity of alcohol intoxication and hangovers.
Furthermore, fructose and glucose did not have a significant effect on ethanol
elimination rate or on blood acetaldehyde concentration during the experiment.
Although they significantly inhibited ethanol-induced metabolic disturbances
(such as the decrease in blood sugar concentration, increase in blood lactate
concentration during hangover, ketone body concentrations, etc.), the sugars
did not significantly influence the symptoms of alcohol intoxication and
hangover. These findings do not support the suggestions offered by MedlinePlus.com,
iloveindia.com, and howstuffworks.com to drink fruit juices and consume high
levels of fructose. Although HowStuffWorks.com
and www.MedlinePlus.com both stated
that there was evidence that fructose helped the body get rid of toxic
byproducts, this study by Ylikahri et al. does not confirm
this claim.

The
strength of this experimental design is in the large number of participants
with a relatively similar background concerning alcohol intake. In addition,
Ylikahri et al. had done three studies on alcohol metabolism prior to this
research study, which allowed the researcher to address and correct issues that
had come up with the previous studies.

Another controlled experimental
study by Seppälä, Leino, Linnoila, Huttunen, & YIikahri (1976) tested the
efficacy of glucose or fructose in diminishing hangover symptoms. Out of a
total of forty healthy male volunteers, 10 subjects served as controls and had
no alcohol, while thirty consumed ethanol from 6 – 9 PM, which resulted in a hangover
the following morning. 10 out of those 30 participants were only given ethanol
(no sugar), and the remaining 20 subjects were administered fructose or glucose
(1 g/kg) during the same evening or the next morning (0.5 g/kg). The
researchers recorded psychomotor performance using three tests during the
hangover phase, and the hangover intensity was determined subjectively (with
rating scale I) and objectively (using rating scale II). Moreover, blood ethanol, acetaldehyde and
glucose concentrations were examined, and the testing was done three times at 8
AM, 10 AM, and 12 PM.

Seppälä et al. found that there was no
difference between the three alcohol groups on rating scale II, but the group
that received both the alcohol and sugar during the evening had slightly higher
ratings on rating scale I compared with the other alcohol groups. In addition,
they found that people in the ethanol only group significantly made more
mistakes on the reaction tests in the hangover phase, but this consequence was
eliminated by when sugar was simultaneously administered. However, there were
more mistakes on one coordination test for those who received both ethanol and
sugars. Furthermore, the researchers could not find any significant difference
in the blood concentrations of ethanol and acetaldehyde between the alcohol
groups. The researchers concluded that the cause of impaired psychomotor skill
may not be directly related to the pathophysiology of the hangover because
there was no significant correlation between the intensity of hangover and the
impairment of psychomotor performance. From the results of this study, fructose
and glucose had neither preventative nor curative effects on the participants
who drank and suffered from hangovers. These findings are similar to those
found by Ylikahri et al., and yet again, the results do not
suggest that there is any benefit of consuming fructose or glucose to alleviate
hangover symptoms.

The
problem with this study is the small number of subjects (n=10) in each of the
experimental groups. With a small sample size, it would be difficult to
eliminate or cancel out personal differences among the volunteers, such as
tolerance levels, personality, family history of alcoholism, etc. Also, the
objective rating scale only ranged from 0 to 2 for the determination of
hangover symptoms, which seems like a small range.

Soterakis & Iber (1975)
conducted a study to compare the effects of oral sucrose, fructose, and glucose
on speeding up the elimination of alcohol from the blood. Eight chronic
alcoholic males, who had been abstinent from alcohol for at least a week,
participated in the study. After fasting over night, the volunteers consumed a
lemon-flavored solution of glucose, fructose, or sucrose. After 30 minutes,
intravenous alcohol was injected in the participants bloodstream. Blood samples
were collected in the fasting state and then hourly for 6 hours after the
alcohol was administered. The researchers found that fructose and sucrose had
accelerated rates of alcohol disappearance from the blood compared to glucose,
although all sugars lead to the removal of alcohol from the bloodstream. This
study supports the idea that sugars, especially sucrose and fructose, can help
alleviate hangover symptoms by removing alcohol from the blood faster than
normal.

These
findings contradict the previous two research results. Perhaps the small number
of participants (n=8 in total) and type of participant (here, they had
alcoholic male participants, while the other studies had healthy males) had an
effect on the findings. To make sure that it was the effect of the sugars and
not other confounding variables that reduced the alcohol content in the blood,
this study should be repeated with more volunteers of good physical health.

The verdict?

The
scientific studies that were reviewed indicated that vitamin B and cysteine
were effective in soaking up the excess acetaldehyde in the body of rodents. A
combination of the vitamin B and cysteine prevented deaths in all of the mice
given a LD-90 dosage of acetaldehyde, and NAC protected the rat livers from
ethanol-induced damage. In addition, pyritinol (a form of vitamin B6) was found
to better prevent hangover symptoms compared to a placebo. Although these
findings suggest some efficacy in the use of cysteine and vitamin B for
hangover treatments, further research is necessary, preferably with human
participants, before a definite answer is found. In the meantime, it would not
be deleterious to take cysteine or vitamin B supplements. After a night of
drinking and vomiting, your body will thank you for replenishing it with much
needed nutrients.

Sugars were suggested by
most websites for the prevention and alleviation of hangover symptoms. However,
the literature seems a bit mixed in the effectiveness of glucose, sucrose, and
fructose in treating hangovers or increasing the body’s rate of metabolizing
alcohol. Although there appears to be a general consensus in the
medical/scientific community that fructose aids in blood alcohol clearance,
there are several studies that indicate otherwise. A meta-analysis is
recommended to compare all the findings of research studies involving ethanol
and sugars. This way, several results can be compared and summarized. Eating
fruits or drinking juices may not be the magical cure to your hangover, but it
will at least hydrate you and provide you with vitamins and antioxidants. Go ahead
and enjoy your breakfast (or lunch…or maybe even dinner) with a glass of juice.

The
best and foolproof way to avoid a hangover is to abstain from alcohol or limit intake.
So next time you wake up with veisalgia, remind yourself that you should never
drink that much again!